Would you recommend switching to DAPT for patients on anticoagulation who develop symptoms of a TIA secondary to ICAD?

It is important to remember that there is more to stroke secondary prevention than antithrombotics. Our use of DAPT in ICAD comes from the SAMMPRIS trial, in which patients in the control group did better than expected compared to historical controls with ICAD in the WASID trial. Recall however, tha...

As we know the mechanism of stroke in ICAD:

1. Artery to artery embolism
2. Perforator disease
3. Hypoperfusion

For 1, 2 the best treatment is optimal medical management. While for 3, the treatment can be angioplasty/stenting.

If we looked for WASID trial which randomly assigned patients with TIA or stroke...

I would consider it. If there is an indication for anticoagulation, would continue the anticoagulant and add aspirin only for 30 days if safe.